As revenue integrity departments continue to evolve, facilities are often faced with the challenge of determining which tasks must fall to these departments and which are best suited for other revenue cycle roles. With so many department functions overlapping, defining revenue integrity-specific functions is a complex task.
Transitioning to an electronic health system comes with its challenges, from learning new software systems to updating staff roles. Understanding the resources your facility has available is critical to adapting to these changes.
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a treasure trove of data that can help hospitals adapt to the world of value-based purchasing, reduce risk, and stay ahead of audits. But understanding how to...
Claims returned with NCCI edits or medically unlikely edits (MUE) can easily be lost in the shuffle. Often, it’s not clear who is responsible for resolving an edit, leading to further delays with accounts receivable. Properly...
Every piece of a cost report tells CMS your facility’s story, and it’s your responsibility to ensure the story is accurate. The data included on cost reports can impact a facility’s revenue for years to come—influencing payment on...
Prioritization and time management are crucial when it comes to leading a revenue integrity department.Prioritization and time management are crucial when it comes to leading a revenue integrity department. Kimberly Yelton, RHIA, CCS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, and director of revenue integrity at WakeMed Health & Hospitals in Raleigh, North Carolina, toldNAHRIabout her experience with this when planning and following-through with department initiatives.
Tasked with the impossible—reviewing 100% of charges before they go out the door—the revenue integrity department at Yale New Haven Health in New Haven, Connecticut, knows the importance of having a reliable staff to get the job done right.
With healthcare billing growing in complexity each year, healthcare organizations must take extra steps to maximize reimbursement and maintain compliance.
